Abstract
Venous thromboembolism (VTE) in patients with COVID-19 in intensive care units (ICU) is frequent, but risk factors (RF) remain unidentified. In this meta-analysis (CRD42020188764) we searched for observational studies from ICUs reporting the association between VTE and RF in Medline/Embase up to 15 April 2021. Reviewers independently extracted data in duplicate and assessed the certainty of the evidence using the GRADE approach. Analyses were conducted using the random-effects model and produced a non-adjusted odds ratio (OR). We analysed 83 RF from 21 studies (5296 patients). We found moderate-certainty evidence for an association between VTE and the D-dimer peak (OR 5.83, 95%CI 3.18–10.70), and length of hospitalization (OR 7.09, 95%CI 3.41–14.73) and intubation (OR 2.61, 95%CI 1.94–3.51). We identified low-certainty evidence for an association between VTE and CRP (OR 1.83, 95% CI 1.32–2.53), D-dimer (OR 4.58, 95% CI 2.52–8.50), troponin T (OR 8.64, 95% CI 3.25–22.97), and the requirement for inotropic drugs (OR 1.67, 95% CI 1.15–2.43). Traditional VTE RF (i.e., history of cancer, previous VTE events, obesity) were not found to be associated to VTE in COVID-19. Anticoagulation was not associated with a decreased VTE risk. VTE RF in severe COVID-19 correspond to individual illness severity, and inflammatory and coagulation parameters.
Highlights
We recently demonstrated that patients admitted to the intensive care units (ICU) had higher risk of venous thromboembolism (VTE) than patients admitted in general ward [4]
We identified moderate-certainty evidence for an association between venous thromboembolic events (VTE) risk and the length of stay in hospitalization [19,25], whereas the disease duration before hospitalization [19,26,35], the disease duration before admission to the intensive care units [17,26], the length of stay in the intensive care unit [19,28,30], or the disease duration before VTE screening [17,23] were not found to be associated with the risk for VTE
In the present meta-analysis that encompasses 5296 ICU patients from 21 observational studies, we identified low –to moderate-certainty evidence for the risk factors for VTE, including the COVID-19 severity and biological parameters (i.e., D-dimer levels, disseminated intravascular coagulation (DIC) International Society on Thrombosis and Haemostasis (ISTH) criteria, C-reactive protein (CRP) level, troponin T, procalcitonin, thrombocytopenia)
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for an outbreak of respiratory disease called Coronavirus Infectious disease 2019 (COVID-19) [1], which is a worldwide global burden for public health. Severe cases of COVID-19 are characterized by sepsis-related coagulopathy [2], platelet activation, and endothelial dysfunction [3]. The reported incidence of venous thromboembolic events (VTE) in COVID19 is highly variable, suggesting that individual risk factors influence the thrombotic risk. We recently demonstrated that patients admitted to the intensive care units (ICU) had higher risk of venous thromboembolism (VTE) than patients admitted in general ward [4]
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